Annals for Educators - December 2022
Authors: Christine Laine
Journal: Annals of Internal Medicine (2022)

Web ExclusivesDecember 2022Annals for Educators - December 2022FREEChristine Laine, MD, MPHChristine Laine, MD, MPHSearch for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/AWED202212200 SectionsAboutVisual AbstractPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Clinical Practice PointsPerioperative Safety and Early Patient and Device Outcomes Among Subcutaneous Versus Transvenous Implantable Cardioverter Defibrillator Implantations. A Randomized, Multicenter TrialSubcutaneous implantable cardioverter defibrillators (ICDs) have no intravascular components and therefore cannot cause lead-related complications. This randomized trial compares perioperative complications and effectiveness of subcutaneous ICDs with transvenous ICDs.Use this article to:Review the indications for ICDs.Ask your learners to list the complications that are associated with ICDs.Discuss why a randomized controlled trial provides a more definitive answer to the research question the researchers sought to answer than prior observational studies comparing subcutaneous and transvenous ICDs.Effectiveness of mRNA COVID-19 Vaccine Boosters Against Infection, Hospitalization, and Death: A Target Trial Emulation in the Omicron (B.1.1.529) Variant EraThis retrospective matched cohort study, which was designed to emulate a target trial of booster vaccination versus no booster, sought to determine mRNA booster vaccine effectiveness against SARS-CoV-2 infection, hospitalization, and death in the Omicron era by booster type, primary vaccine type, time since primary vaccination, age, and comorbidity burden.Use this article to:Ask a colleague with expertise in research methods to join your session to review how a target trial emulation is conducted.Ask your learners to speculate on why a randomized trial to determine the effectiveness of mRNA COVID-19 vaccine boosters would be difficult to conduct at the present time.Discuss how the results of this study could be summarized for patients who are reluctant to receive the COVID-19 vaccine.Total Ankle Replacement Versus Arthrodesis for End-Stage Ankle Osteoarthritis. A Randomized Controlled TrialAnkle Osteoarthritis: Successful Completion of a Challenging Clinical Trial Comparing Surgical TreatmentsSurgical options for end-stage ankle osteoarthritis include total ankle replacement and ankle fusion. This randomized trial compared the benefits on walking and standing clinical scores and adverse effects of each option between baseline and 52 weeks after surgery. The accompanying editorial discusses the trial findings and the challenges of successfully conducting randomized trials of surgical interventions.Use this article and the editorial to:Discuss factors that contribute to randomized trials of surgical interventions being less common than trials of nonsurgical interventions.How were the researchers able to overcome some of the barriers that were identified?Invite an orthopedic surgeon to your session to describe the 2 interventions compared in this trial.Ask your learners how they might use the results of this trial to help a patient with severe ankle osteoarthritis choose between replacement and fusion.Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers. A Randomized TrialComparative Effectiveness of Mask Type in Preventing SARS-CoV-2 in Health Care Workers: Uncertainty PersistsWhether medical masks offer similar protection against COVID-19 compared with N95 respirators is uncertain. This randomized trial, which enrolled participants in Canada, Israel, Pakistan, and Egypt, evaluated whether medical masks are noninferior to N95 respirators for COVID-19 prevention in health care workers providing routine care. The accompanying editorial discusses the findings and the substantial uncertainty that remains about the optimal mask type.Use this article and the editorial to:Review the masking protocol currently in effect at your institution. How has the protocol changed over the course of the pandemic?Discuss potential explanations for the discrepancy between the overall and country-specific findings.Ask your learners which country's findings they think are currently most applicable to your institution.Ask your learners to design a randomized trial that would more definitively identify the comparative effectiveness of different masking policies in the health care setting. What settings would they study? Whom would they recruit to participate in the trial? What masking interventions would they study? What outcomes would they measure?Contact Tracing and Exposure Investigation in Response to the First Case of Monkeypox Virus Infection in the United States During the 2022 Global Monkeypox OutbreakAfter the first U.S. case of monkeypox was identified, contact tracing and exposure investigations were done statewide in multiple health care facilities and community settings in Massachusetts. This article reports on the application of a risk assessment and stratification framework for contacts in community and health care settings.Use this article to:Review CDC guidelines on personal protective equipment to use when caring for patients with suspected or confirmed monkeypox infection.Invite an infection control expert to your session to discuss how your institution would handle a situation involving in-hospital exposure of unprotected patients and staff to monkeypox.Discuss factors that may have contributed to the successful prevention of community and health care setting transmission of infection in this case.Characteristics of High-Need, High-Cost Patients. A “Best-Fit” Framework SynthesisIdentifying High-Need, High-Cost Patients: A Real-World PerspectiveA small percentage of patients may disproportionately account for a large share of health care use and cost. Identifying patients with modifiable health care use is challenging. The authors reviewed all studies that identified characteristics of high use or high cost and provide a “best fit” framework to organize findings. The accompanying editorial offers a real-world perspective on how the modified framework contributes to identifying patient needs, what appears to be missing, and possible next steps.Use this article and the editorial to:Watch the video summarizing the review. Ask your learners to reflect on “high-need, high-cost” patients they have encountered. What factors contributed to these patients' high utilization of health care?Speculate on interventions that could decrease utilization without compromising patient well-being, and could potentially improve it.Beyond the GuidelinesHow Would You Manage This Patient With Chronic Insomnia? Grand Rounds Discussion From Beth Israel Deaconess Medical CenterRecent guidelines on chronic insomnia strongly recommend multicomponent cognitive behavioral therapy and suggest a limited number of medications that might be useful. Referencing these guidelines, 2 experts in sleep disorders, a clinical psychologist and a physician, discuss treatment for a patient who had been taking medication for his insomnia.Use this article to:Watch the patient video with your learners, and then ask them what they would recommend for this patient with chronic insomnia.Review the American College of Physicians clinical guidelines on care of patients with chronic insomnia. Invite a clinical psychologist to your session to describe how cognitive behavioral therapy is done and its local availability.Review the potential benefits and harms of pharmacologic therapy for insomnia. What factors should promote caution in prescription of these agents?Have your learners test their knowledge by completing the quiz that accompanies the article.Monoclonal Gammopathy of Undetermined SignificanceMonoclonal gammopathy of undetermined significance (MGUS) is of considerable clinical importance to all primary care physicians given its high prevalence in the general population. It has a variable but lifelong risk for progression to hematologic cancer, such as multiple myeloma, Waldenström macroglobulinemia, or light-chain amyloidosis. In addition, MGUS has been associated with several nonmalignant but symptomatic disorders that require therapy directed toward eliminating the monoclonal gammopathy. Thus, it is important not only to understand the essentials of diagnosing and monitoring patients with MGUS but also to recognize when to refer patients with MGUS to a specialist.Use this article to:Discuss the criteria for the diagnosis of MGUS.Invite a hematologist/oncologist to discuss the cancers associated with MGUS and how to monitor patients to identify these complications.Discuss the criteria for referring a patient with MGUS to a specialist.Test your learners' knowledge by having them complete the quiz that accompanies the article and then reviewing the correct answers.Do you like reading Annals for Educators? Receive it direct to your inbox. Sign up for the Annals for Educators alert today. Comments0 CommentsSign In to Submit A Comment Author, Article, and Disclosure InformationAffiliations: From the Editors of Annals of Internal Medicine and Education Guest Editor, Gretchen Diemer, MD, FACP, Associate Dean of Graduate Medical Education and Affiliations, Thomas Jefferson University. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics December 2022Volume 175, Issue 12Page: ED12 ePublished: 20 December 2022 Issue Published: December 2022 Copyright & PermissionsCopyright © 2022 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...